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NPI Code Detail

MEDICARE: MILLARD L TIERCE IV DO

MEDICARE: MILLARD L TIERCE IV DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207K00000XAllergy & Immunology Physician

General Provider Information

NPI Number : 1609536275
Entity Type Code : Organization
Provider Name (Legal Business Name) : MILLARD L TIERCE IV DO
Provider Business Mailing Address
First Line : 4200 S HULEN ST STE 230
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4924
Country : US
Telephone Number : 817-315-2550
Fax Number :
Provider Business Practice Location Address
First Line : 4200 S HULEN ST STE 230
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-4924
Country : US
Telephone Number : 817-315-2550
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MILLARD L TIERCE IV
Credential : MD
Telephone Number : 817-944-4209
Provider Enumeration Date : 12/23/2021
Last Update Date : 12/23/2021

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Directions to “MILLARD L TIERCE IV DO ” Practice Location

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